Wingspan 支架治疗症状性大脑中动脉严重粥样硬化狭窄的安全性和有效性  

Safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent

作　　者：蔡栋阳 王子亮[1] 李天晓[1] 贺迎坤[1] 许斌[1] 薛绛宇[1] 吴立恒[1] 朱良付[1] 白卫星[1] 

机构地区：[1]郑州大学人民医院河南省人民医院介入科,450003

出　　处：《中华放射学杂志》2014年第5期408-412,共5页Chinese Journal of Radiology

摘　　要：目的：评价Wingspan支架治疗症状性大脑中动脉严重粥样硬化狭窄的安全性和有效性。方法回顾性分析102例行大脑中动脉Wingspan支架植入术患者的临床资料，所有患者术前有大脑中动脉粥样硬化性狭窄病变相关的缺血性卒中或短暂性脑缺血发作（ TIA）症状，并且术前均经DSA证实血管狭窄程度为70％～99％。记录围手术期（30 d内）及临床随访中患者卒中、死亡、TIA情况，术后6个月进行影像随访（ DSA或CTA），记录血管再狭窄情况。采用χ2检验或Fisher精确概率法比较不同临床及病变特点患者术后发生支架内再狭窄（ISR）的差异。结果102例中，100例（98.0％）成功实施支架植入术，狭窄率由术前的（81.0±8.4）％改善到术后即刻的（15.3±6.7）％。围手术期8例（7.8％，8/102）发生脑血管相关不良事件，包括卒中或死亡7例，TIA 1例。82例患者临床随访（29±15）个月，再发缺血性事件9例，包括同侧缺血性卒中4例（均为小卒中），同侧性TIA 3例，非同侧性卒中2例。55例患者影像随访（11±9）个月，8例（14.3％）出现ISR，其中3例为症状性再狭窄。年龄≤49岁的患者较年龄＞49岁者 ISR 发生率高，分别为25.0％（7/28）和3.7％（1/27），病变长度＞7.5 mm 的患者较病变长度≤7.5 mm 的患者 ISR 发生率高，分别为25.0％（7/28）和3.7％（1/27），但差异无统计学意义（P值均＞0.05）。结论症状性大脑中动脉粥样硬化狭窄Wingspan支架植入术围手术期卒中或病死率较低，对缺血性卒中的中远期预防效果肯定。Objective To assess the safety and efficacy of the treatment for symptomatic atherosclerotic high-grade stenosis in middle cerebral artery with Wingspan stent.Methods The medical records of Wingspan stenting for 102 cases with symptomatic middle cerebral artery high-grade stenosis from February 2008 to May 2012 in our hospital were reviewed retrospectively.All of the patients suffered from ischemic stroke or transient ischemic attack （ TIA ） attributed to the atherosclerotic high-grade stenosis in middle cerebral artery and the stenosis of 70%to 99%was confirmed by DSA before the stenting procedure.All the stroke, death, TIA within 30 days after the stenting procedure or during the follow-up beyond 30 days were observed and recorded.In-stent restenosis were recorded after DSA or CTA was performed 6 months later.χ2 test or Fisher exact test was used to compare in-stent restenosis rate among patients with different clinical and pathological conditions.Results Stenting procedure were successfully performed in 100 patients （98.0%,100/102）.The mean degree of stenosis was reduced from （81.0 ±8.4）% to （15.3 ±6.7）%right after surgery.Eight adverse cardiovascular events （7.8 %, 8/102） occured within 30 days ,including seven stroke or death （ 6.9%, 7/102 ） and 1 TIA.The mean clinical follow-up duration was （ 29 ± 15） months in 82 patients, and 9 ischemic events were documented （4 cases of ipsilateral recurrent stroke , 3 cases of ipsilateral TIA, and 2 cases of contralateral ischemic stroke ）.The mean radiological follow-up duration was （11 ±9） months in 55 patients.Among them, 8 patients （14.3%） had in-stent restenosis and 3 patients had symptomatic restenosis.The restenosis rate in patients with age ≤49 years.（25.0%,7/28） was higher than those with age 〉49 years （ 3.7%,1/27 ） （ P〉0.05 ）.The restenosis rate in patients with＆amp;nbsp;lesion size〉7.5 mm（25.0%,7/28） was higher than those with lesion size ≤7.5 mm （3.7%,1/27）（P〉0.05）.Conclusions

关 键 词：动脉粥样硬化 大脑中动脉 支架 放射学 介入性 

分 类 号：R743[医药卫生—神经病学与精神病学]